Introduction <p>This study aims to evaluate the impact of using FreeStyle Libre continuous glucose monitoring (FSL-CGM) on maternal glucose control and obstetric and neonatal outcomes among women with gestational diabetes mellitus (GDM).</p> Methods <p>A total of 3062 women with GDM in gestational weeks 24–28 were enrolled in this study and divided into FSL-CGM and self-monitoring of blood glucose (SMBG) groups according to the method of monitoring blood glucose. Nearest-neighbor matching propensity score matching (PSM) was used to balance covariates at a ratio of 1:2.</p> Results <p>Compared with the first 6&#xa0;days during the study period, the index of glycemic variability, such as the mean largest amplitude of glycemic excursions (LAGE), average daily risk range (ADRR) and glucose management indicators (GMI) during the last 6&#xa0;days were improved (all <i>p</i> &lt; 0.05). The fasting blood glucose before delivery in the FSL-CGM group was lower than that in the SMBG group (<i>p</i> &lt; 0.05). In the normal weight subgroup, the FSL-CGM group had a lower gestational weight gain (GWG) than the SMBG group (<i>p</i> &lt; 0.05). The incidence of neonatal hypoglycemia was higher in the SMBG group than in the FSL-CGM group (<i>p</i> &lt; 0.05).</p> Conclusions <p>This study demonstrated that FSL-CGM helps reduce maternal glycemic variability and the incidence of neonatal hypoglycemia. Additionally, FSL-CGM may contribute to appropriate gestational weight gain during pregnancy.</p> Trial Registration <p>ClinicalTrials.gov identifier, NCT05003154.</p>